Prescription Painkillers: When Are They Too Much of a Good Thing?

Frank B.* drives a truck to support himself and his family. When he was 47, he injured his back and could not work for several weeks. With the help of physical therapy, an epidural and an opioid prescription painkiller, he was able to return to work; but lifting heavy boxes was very painful. He took more medication so that he could stay on the job. He did not consult a doctor because he was able to buy the additional pills at truck stops. He consumed large quantities of "energy" drinks to stay awake at the wheel. When he was home, he spent most of his free time sleeping. He stopped coaching the teams his kids played on and became more and more short-tempered with his wife and children. Neither he nor his wife realized that he had become dangerously dependent on his prescription painkiller.

Stella S.* was 84 when she was in a serious automobile accident. She broke several ribs and shattered an elbow. After surgery she was in great pain. The opioid painkiller her physician prescribed helped enormously, but the pain persisted and the painkiller was less effective except in larger doses. She had returned home with a home health aide and enough medication for a month -- not counting the medications left over from her husband's lengthy terminal illness. Her daughter, who visited frequently, began to notice that her mother, who was devoted to elegance, often looked disheveled. She was also difficult to talk with -- distracted, forgetful and short of words, which often came out slurred. She seemed disinterested in almost everything, even her grandchildren. The daughter spoke with the doctor, who thought she might have had a minor stroke or that the accident, the surgery, and the anesthesia might have precipitated symptoms of dementia. In fact, she had become addicted to her medication.

Many people who need prescription painkillers to manage chronic pain become dangerously dependent on their medications. At the extreme they take overdoses, and some of them die as a result. According to the CDC, overdoses of prescription painkillers have become a national epidemic.

Many people don't notice the insidious development of dangerous drug dependency, which is why it is important to watch for symptoms of addiction if you or someone you care about is taking a prescription painkiller.

What are the signs that use of a prescription painkiller has become too much of a good thing?

1. Increased Use: The most obvious sign of a problem is using more and more medication. Excuses abound, but increased use is likely to reflect growing dependency on the medication to be able to get through a day or to sleep at night.

2. Poor performance at work and/or at home: Not being able to work as well as normal and not being able to keep up with normal responsibilities at home -- cleaning, cooking, getting the kids ready for school, etc. -- are signs that something is wrong. Too much medication could be the reason for not keeping up.

3. Changes in relationships: People in chronic pain and/or taking more painkillers than they should often develop problems with relationships. Whether they are fighting pain or "high" from the meds, they often are distracted, irritable and seem disinterested in the important people in their lives.

4. Changes in mood: People in pain are often in a bad mood. They may be edgy, quick to anger and sometimes abusive. Small problems become matters of extreme frustration, to which they over-react. Sometimes they become deeply unhappy and pessimistic.

5. Other mental changes: People overdoing it with medications may also exhibit other mental changes. They may not be able to concentrate, be more forgetful or be easily frustrated and impatient. They may also become increasingly suspicious, even paranoid. In older people, it is easy to confuse the impact of excessive use of painkillers with the kinds of cognitive impairments we erroneously expect as people age

6. Changes in activity: People dealing with pain frequently change their patterns of activity. A man who used to play with his children sits silently in front of a TV, ignoring them. A woman who used to go to lunch with friends eats at her desk so she can leave work early. A man -- or a woman -- in an intimate relationship suddenly loses interest in sex. A stamp collector leaves his treasured possessions scattered on a table top instead of in archival storage.

7. Changes in appearance: People overdoing it with painkillers often look different. Stylish dressers become unkempt. Big talkers become silent. Speech may become slurred, disorganized, or irrational. People with good physical coordination suddenly find it difficult to keep their balance.

8. Putting drugs first: A person who has become addicted may spend more and more time getting drugs whether by doctor shopping, theft from other people's medicine cabinets or buying drugs from street dealers. At some point, getting drugs becomes more important than work, family or basic functions like eating.

Sadly, these signs of becoming addicted to a prescription painkiller often go unnoticed. That is why it is important to monitor changes that take place after a painkiller is prescribed. There may be other reasons for changes in emotions and behavior; even just living with pain can be the cause. Whether it's addiction or something else, it is important to deal with the problems.

*Frank B. and Stella. S. are composites of typical cases of addiction to prescription painkillers.

This post was co-written with Deborah Langosch, Ph.D., LCSW, Director of the Kinship Care Program at the Center for Trauma Program Innovation at Jewish Board of Family and Children's Services. She is also in private practice in Brooklyn.

Help is available from your physician or a local treatment program. If you don't know where to turn, call -1-800-662-HELP or visit http://www.samhsa.gov/treatment.